As telecommunication technology has advanced and costs have declined over the past decade, there has been a steady growth in telemedicine. Much of this growth, however, has been in the form of feasibility studies and pilot trials. As a result there is little convincing evidence of the cost effectiveness of many applications, apart from teleradiology (box). This paper reviews recent evidence and describes clinical applications where there is early evidence that telemedicine is not only of clinical benefit but cost effective too.

What is telemedicine?

Telemedicine is an umbrella term that encompasses any medical activity involving an element of distance. In its commonly understood sense, in which a doctor-patient interaction involves telecommunication, it goes back at least to the use of ship to shore radio for giving medical advice to sea captains. A few years ago the term telemedicine began to be supplanted by the term telehealth, which was thought to be more “politically correct,” but in the past year or so this too has been overtaken by even more fashionable terms such as online health and e-health.

The implementation of telemedicine in routine health services is being impeded by the lack of scientific evidence for its clinical and cost effectiveness. The British government has stated that, without such evidence, telemedicine will not be widely introduced.3 Policymakers have been warned against recommending investment in unevaluated technologies.4 Recent advances in telemedicine can therefore be considered to be shown by studies that have obtained evidence of cost effectiveness.

Recent advances

The first randomised controlled trial of home telenursing showed evidence of its cost effectiveness

Electronic referrals are a cheaper and more efficient way to handle outpatients

General practitioner teleconsulting may be cheaper than traditional consulting in some circumstances

Decision support over video links for nurse practitioners dealing with minor injuries is shown to be effective …